Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To evaluate the efficacy and safety of mitoxantrone hydrochloride liposome injection in the treatment of peripheral T-cell lymphoma (PTCL) in a real-world setting.Methods:This was a real-world ambispective cohort study (MOMENT study) (Chinese clinical trial registry number: ChiCTR2200062067). Clinical data were collected from 198 patients who received mitoxantrone hydrochloride liposome injection as monotherapy or combination therapy at 37 hospitals from January 2022 to January 2023, including 166 patients in the retrospective cohort and 32 patients in the prospective cohort; 10 patients in the treatment-na?ve group and 188 patients in the relapsed/refractory group. Clinical characteristics, efficacy and adverse events were summarized, and the overall survival (OS) and progression-free survival (PFS) were analyzed.Results:All 198 patients were treated with mitoxantrone hydrochloride liposome injection for a median of 3 cycles (range 1-7 cycles); 28 cases were treated with mitoxantrone hydrochloride liposome injection as monotherapy, and 170 cases were treated with the combination regimen. Among 188 relapsed/refractory patients, 45 cases (23.9%) were in complete remission (CR), 82 cases (43.6%) were in partial remission (PR), and 28 cases (14.9%) were in disease stabilization (SD), and 33 cases (17.6%) were in disease progression (PD), with an objective remission rate (ORR) of 67.6% (127/188). Among 10 treatment-na?ve patients, 4 cases (40.0%) were in CR, 5 cases (50.0%) were in PR, and 1 case (10.0%) was in PD, with an ORR of 90.0% (9/10). The median follow-up time was 2.9 months (95% CI 2.4-3.7 months), and the median PFS and OS of patients in relapsed/refractory and treatment-na?ve groups were not reached. In relapsed/refractory patients, the difference in ORR between patients with different number of treatment lines of mitoxantrone hydrochloride liposome injection [ORR of the second-line, the third-line and ≥the forth-line treatment was 74.4% (67/90), 73.9% (34/46) and 50.0% (26/52)] was statistically significant ( P = 0.008). Of the 198 PTCL patients, 182 cases (91.9%) experienced at least 1 time of treatment-related adverse events, and the incidence rate of ≥grade 3 adverse events was 66.7% (132/198), which was mainly characterized by hematologic adverse events. The ≥ grade 3 hematologic adverse events mainly included decreased lymphocyte count, decreased neutrophil count, decreased white blood cell count, and anemia; non-hematologic adverse events were mostly grade 1-2, mainly including pigmentation disorders and upper respiratory tract infection. Conclusions:The use of mitoxantrone hydrochloride liposome injection-containing regimen in the treatment of PTCL has definite efficacy and is well tolerated, and it is a new therapeutic option for PTCL patients.

Objective:To investigate the effect of compound matrine injection on morphine tolerance in mice with lung cancer in situ and the expressions of multidrug resistance gene 1 (MDR1) and P-glycoprotein (P-gp).Methods:A mouse model of lung cancer in situ and morphine tolerance mode was established. The mice were injected with gradient concentration of compound matrine. The pain thresholds under different conditions were measured by thermal radiation tail-flick method. The mRNA level of MDR1 was tested by reverse transcription polymerase chain reaction (RT-PCR) and the protein level of P-gp was detected by western blot. The DNA binding activity of cyclophosphoadenosine response element binding protein (CREB) to the promoter of MDR1 gene was detected by electrophoretic mobility shift assay (EMSA).Results:The maximum analgesic percentage (MPE) of the mice in the morphine group was (85.21±6.53)% on the 8th day, and decreased to (38.45±5.52)% and (28.14±4.52)% on the 10th and 12th day, respectively, which indicated the morphine tolerance of mice with lung cancer in situ.The MPE of the mice in the group treated with morphine and compound matrine injection (300 mg/kg) was (79.34±6.50)% on the 8th day, and decreased to (62.16±5.53)% and (40.20±4.50)% on the 10th and 12th day, respectively.The results of RT-PCR assay showed that the relative expression levels of MDR1 mRNA in the brain tissues of mice in the morphine group, saline group, morphine combined with compound matrine injection (300 mg/kg) group and compound matrine injection (200 mg/kg) group were 2.33±0.79, 1.04±0.38, 1.37±0.38, and 1.43±0.53, respectively. There were statistically significant differences between the morphine group and the normal saline group, the morphine group and the morphine combined with compound matrine injection (300 mg/kg) group ( P<0.05). There was no significant difference between the normal saline group and the compound matrine injection (200 mg/kg) group ( P=0.05). The results of western blot showed that the relative expression levels of P-gp protein in the brain tissue of mice in the morphine group, saline group, and morphine combined with compound matrine injection (300 mg/kg) group were 1.86±0.40, 1.00±0.23, and 1.27±0.27, respectively. The expression of P-gp protein in the morphine group was significantly higher than those of the normal saline group and the morphine combined with compound matrine injection (300 mg/kg) group ( P<0.05). The DNA-binding activity of CREB in the saline group was (0.23±0.07) Pu, significantly lower than (0.89±0.23) Pu of morphine combined with naloxone group and (0.80±0.23) Pu of morphine group ( P<0.05). While the CREB DNA binding activity of morphine combined with compound matrine injection (300 mg/kg) group was (0.79±0.21) Pu, implicated that compound matrine had marginal effect on the DNA-binding activity of CREB ( P>0.05). Conclusion:Compound matrine injection can significantly improve morphine tolerance and drug resistance of lung cancer through inhibiting the upregulations of MDR1 and P-gp induced by morphine.

Objective:To investigate the effect of compound matrine injection on morphine tolerance in mice with lung cancer in situ and the expressions of multidrug resistance gene 1 (MDR1) and P-glycoprotein (P-gp).Methods:A mouse model of lung cancer in situ and morphine tolerance mode was established. The mice were injected with gradient concentration of compound matrine. The pain thresholds under different conditions were measured by thermal radiation tail-flick method. The mRNA level of MDR1 was tested by reverse transcription polymerase chain reaction (RT-PCR) and the protein level of P-gp was detected by western blot. The DNA binding activity of cyclophosphoadenosine response element binding protein (CREB) to the promoter of MDR1 gene was detected by electrophoretic mobility shift assay (EMSA).Results:The maximum analgesic percentage (MPE) of the mice in the morphine group was (85.21±6.53)% on the 8th day, and decreased to (38.45±5.52)% and (28.14±4.52)% on the 10th and 12th day, respectively, which indicated the morphine tolerance of mice with lung cancer in situ.The MPE of the mice in the group treated with morphine and compound matrine injection (300 mg/kg) was (79.34±6.50)% on the 8th day, and decreased to (62.16±5.53)% and (40.20±4.50)% on the 10th and 12th day, respectively.The results of RT-PCR assay showed that the relative expression levels of MDR1 mRNA in the brain tissues of mice in the morphine group, saline group, morphine combined with compound matrine injection (300 mg/kg) group and compound matrine injection (200 mg/kg) group were 2.33±0.79, 1.04±0.38, 1.37±0.38, and 1.43±0.53, respectively. There were statistically significant differences between the morphine group and the normal saline group, the morphine group and the morphine combined with compound matrine injection (300 mg/kg) group ( P<0.05). There was no significant difference between the normal saline group and the compound matrine injection (200 mg/kg) group ( P=0.05). The results of western blot showed that the relative expression levels of P-gp protein in the brain tissue of mice in the morphine group, saline group, and morphine combined with compound matrine injection (300 mg/kg) group were 1.86±0.40, 1.00±0.23, and 1.27±0.27, respectively. The expression of P-gp protein in the morphine group was significantly higher than those of the normal saline group and the morphine combined with compound matrine injection (300 mg/kg) group ( P<0.05). The DNA-binding activity of CREB in the saline group was (0.23±0.07) Pu, significantly lower than (0.89±0.23) Pu of morphine combined with naloxone group and (0.80±0.23) Pu of morphine group ( P<0.05). While the CREB DNA binding activity of morphine combined with compound matrine injection (300 mg/kg) group was (0.79±0.21) Pu, implicated that compound matrine had marginal effect on the DNA-binding activity of CREB ( P>0.05). Conclusion:Compound matrine injection can significantly improve morphine tolerance and drug resistance of lung cancer through inhibiting the upregulations of MDR1 and P-gp induced by morphine.

Objective To study the short and long term outcomes in patients after partial hepatectomy carried out for primary hepatocellular carcinoma (PHC) with portal vein tumor thrombosis (PVTF) who were treated with transcatheter arterial chemoembolization (TACE) plus portal vein chemoembolization (PVCE).Methods 57 patients who underwent partial hepatectomy for PHC with PVTT were treated with TACE + PVCE.These patients formed the study group.Another 55 such patients who received TACE only were matched by age and gender to form the control group.Blood samples before and after treatment for these 2 groups were collected to study the serum tumor markers.Any chemotherapy-related toxicity and complications were recorded.The hepatocellular carcinoma recurrence rate and recurrence time were recorded on follow up.Survival analysis was conducted.Results There was no significant difference between the two groups in TACE treatment times (P ＞ 0.05).In the study group,the levels of AFP,IGF-Ⅱ,and IGFBP-2 were significantly lower than those in the control group at 1 month after chemotherapy [respectively,(4.3 ± 0.5) μg/L vs.(4.8±0.6) μg/L,(3.3±0.4) μg/L vs.(4.0±0.5) μg/L,(5.3±0.6) μg/L vs.(5.8 ± 0.6) μg/L;all P ＜ 0.05].The range of follow-up of the patients in this study were 9 to 45 months after operation.The 1 year recurrence rate after operation in the study group was significantly lower than those in the control group (28.1％ vs.47.3％) (P＜0.05).The PFS,OS,2 year and 3 year survival rates were all significantly higher than those in the control group [respectively,(13.4 ± 4.6) m vs.(11.0±3.5) m,(22.6±10.9) m vs.(17.2 ±10.1) m,43.9％ vs.25.5％,33.3％ vs.16.4％].The differences in the PFS and OS between the two groups were significantly different (P ＜ 0.05).There was no significant difference in the rates in toxicity between the two groups (P ＞ 0.05).In the study group,2 patients (3.5％) developed bleeding from esophageal and gastric fundus vein rupture,while there were no such cases in the control group.Conclusion Compared with TACE alone,the combination of PVCE and TACE after partial hepatectomy for patients with PHC with PVTT effectively reduced tumor burden,prevented liver recurrence and improved long-term survival rates,with no significant increase in toxicity and complication rates.

Objective To investigate the effect of gefitinib on mucus hypersecretion by inhibiting epidermal growth factor receptor (EGFR) activity in chronic obstructive pulmonary disease (COPD).Methods Human airway epithelail cell lines 16HBE cells were exposed to cigarette smoke extraction (CSE) to establish the COPD model.EGFR activity was inhibited by tyrosine kinase inhibitor gefitinib.The mRNA expressions of EGFR and MUC5AC were detected by real-time PCR.EGFR,p-EGFR and MUC5AC protein levels were determined by Western blot and ELISA.Results EGFR mRNA level was increased by 12.7％ in CSE and 8.6％ in gefitinib group,but had no significant differences among CSE,gefitinib group and control group (all P＞ 0.05).MUC5AC mRNA levels were enhanced by 141.7％,26.4％ in CSE group and gefitinib group respectively,and there were significant differences among CSE,gefitinib group and control group (all P＜0.05).EGFR protein levels were (600.34±64.58) μg/mg,(632.58±72.94) μg/mg,(584.57±67.39) μg/mg,in control,CSE and gefitinib groups,respectively,and there were no significant differences between groups (all P＞0.05).p-EGFR protein levels were (338.62±45.28) μg/mg,(679.43±78.23) μg/mg,(292.74±59.17) μg/mg in control,CSE and gefitinib groups,respectively.MUC5AC protein levels were(72.80±6.25)μg/mg,(187.00±±10.26)μg/mg,(92.57±8.32)μg/mg in control,CSE and gefitinib groups respectively.Compared with control group,p-EGFR and MUC5AC protein levels were increased significantly in CSE group (both P＜0.05),and had no significant differences in p EGFR and MUC5AC protein levels between control group and gefitinib group.Conclusions CSE may lead to mucus hypersecretion through activating the EGFR-mediated signaling pathways.Gefitinib may inhibit mucus hypersecretion by inhibiting EGFR tyrosine kinanse activity.EGFR may serve as a potential target for COPD.

The regional medical information system calls for regional information resources and hospital-level information resources be interconnected and intercommunicated.To meet this requirement,a HL7 CDA-based solution was proposed based on analysis of the current hospital information resources management.An information resources service portal was built to harmonize the management of both new and old resources,and the hierarchy management based on information granularity.The technical implementation of the system is compliant with the SOA architecture and health information standards.This ensures the interconnection and intercommunication between inner information and outer one,and uses information resources in an efficient,reasonable and safe manner.

ObjectiveTo observe the effects of salmeterol fluticasone on the glucose metabolism and bone density of the elderly patients with chronic obstructive pulmonary disease (COPD) combined with type 2 diabetes mellitus (T2DM).MethodsThirty-one patients with COPD combined with T2DM were divided into 2 groups by random digits table,14 cases in control group were given conventional therapy,17 cases in experimental group were given conventional therapy and fluticasone propionate 50/500 μg,twice a day,for 3 months.The fasting blood glucose,postprandial 2 hours glucose,glycosylated hemoglobin,plasma cortisol and bone density respectively before and after treatment were detected.ResultsIn experimental group,the fasting blood glucose,postprandial 2 hours glucose,glycosylated hemoglobin and bone density before treatment was (5.25 ± 0.21 ) mmol/L,(7.14 ± 0.33 ) mmol/L,(5.58 ± 0.26 )％,( 1.96 ± 0.11 ) g/cm2,and after treatment was(5.31 ± 0.27 ) mmol/L,(7.22 ± 0.29 ) mmol/L,(5.67 ± 0.23 )％,(2.03 ± 0.15 ) g/cm2,there was no significant difference (P ＞ 0.05).In control groups,the fasting blood glucose,postprandial 2 hours glucose,glycosylated hemoglobin and bone density before treatment was (5.33 ± 0.35) mmol/L,( 7.26 ± 0.29 ) mmol/L,( 5.62 ± 0.19 )％,( 1.88 ± 0.20 ) g/cm2,and after treatment was ( 5.36 ± 0.31 ) mmol/L,(7.30 ± 0.35 ) mmol/L,( 5.69 ± 0.26 )％,( 1.98 ± 0.17 ) g/cm2,there was no significant difference (P ＞ 0.05 ).There was no significant difference in plasma cortisol before and after treatment in two groups (P ＞0.05).ConclusionInhaling salmeterol fluticasone for elderly patients with COPD combined with T2DM is safe.

ObjectiveTo study the appearances and dynamic changes of chest high resolution computed tomography (HRCT) in clinically diagnosed critical influenza A (H1N1) pneumonia.MethodsOne hundred chest HRCT scanning examinations were performed in 36 cases of influenza A (H1N1) pneumonia who were diagnosed by the clinical manifestations in one month.The onset,progress and resolve of pulmonary manifestations were analyzed.Results Chest HRCT was performed in six patients,and small patchy opacity presented in three cases and ground-glass opacities presented in the other three cases within 3 days after onset when the disease was at the initial stage.Multiple larger opacities were visualized in all cases at the progressive stage (3 days later after onset),which included the pure ground-glass opacities (9 cases,25.0％ ),ground-glass opacities accompanied by consolidations (20 cases,55.6％),prominent consolidations (7 cases,19.4％),and accompanied pleural lesions (10,27.8％).The lesions strongly progressed within (8.0± 2.6) d and distinctly absorption in all cases (100.0％,36/36) within (16.0±4.8) d after onset of the disease.The pulmonary interstitial hyperplasia was found in 23 cases (63.9％).Dynamic change types of the lesions include absorption after progression,absorption and progression coexistence then absorption and gradually absorption,andabsorptionafterprogressionwas themajor type(41.7％).ConclusionHRCT could distinctly demonstrate the shape,range and dynamic changes of pulmonary lesions of critical influenza A (H1 N1) pneumonia.

Objective To explore the chest features of patients with the novel influenza type A H1N1 on HRCT. Methods One hundred and seventy-two chest HRCT examinations on 163 cases with Influenza type A H1N1 (9 cases were reexamed) were retrospectively analyzed using standard pulmonary window and mediastinal window, respectively. HRCT imaging appearances were summarized. Results Ninety-seven cases showed normal on chest HRCT, while the others showed abnormalities of parenchymal and interstitial. Among them, HRCT identified ground-glass opacity in 35 cases (53.0%), centrilobular nodules in 30 cases (45.5%), thickening of intralobular septa in 31 cases (47.0%), intralobular thin reticulation and micro-nodule in 8 cases (12.1%), single-lobular inflammation in 19 cases (28.8%), consolidation of lung(the large consolidation and multiple small consolidations)in 15 cases (22.7%), pulmonary atelectasis in 3 cases (4.5%), and irregular lines in 2 cases (3.0%). Pleurisy was also revealed including 8 cases with right pleurisy, 5 cases with left pleurisy, and 19 cases with bilateral pleurisy. Mediastinal and axillary lymphadenopathy were found in 7 cases, who were spared of pleural effusion. All above abnormalities resolved quickly after anti- virus treatment. Conclusion Parenchymal and interstitial abnormalities, mediastinum and axillary fossa lymphadenopathy, and pleural effusion were the common findings on HRCT in patients with Influenza type A H1N1, which were similar to those of other viral pneumonia.